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Conflict of interest: No Introduction and Objectives: Tacrolimus is the cornerstone of immunosuppression following liver transplantation (LT). In patients with prolonged orotracheal intubation, enteral administration (oral, nasogastric or sublingual) can result in variable pharmacokinetics and trough levels. Continuous intravenous tacrolimus (CIT) may ensure a more stable dose-to-trough levels ratio. We aimed to describe an implementation strategy and outcomes of CIT in LT recipients. Patients / Materials and Methods: This case series includes consecutive adult LT patients receiving CIT at a single center from 2018 to 2024. CIT was administered to patients who could not receive enteral medication. The CIT dose ranged from 0.01 to 0.02 mg/kg/day, with adjustments based on the patient's clinical condition, and target blood trough levels 5-8 ng/ml. Clinical outcomes included acute cellular rejection, infections, renal and neurologic toxicities. Results and Discussion: Twelve patients received CIT, with a median initiation at 4 days (IQR: 2.5–19) post-LT. The median initial dose was 1 mg/24h (IQR: 0.7–1.0), Six (50%) patients achieved target trough levels at a median of 2.5 days (IQR: 1.5–4). Of the 12 patients, 11 had at least one tacrolimus trough level over 10 ng/ml, 7 had levels over 12 ng/ml, and 3 had levels over 15 ng/ml. The median duration of CIT was 12 days (IQR: 9–22). During CIT administration, complications included seizures (n=1), cytomegalovirus reactivation (n=4) and acute kidney injury (n=3). No cases of acute cellular rejection were observed, and 2 patients died during hospitalization, with deaths not related to CIT. Conclusions: This case series suggests that CIT is a feasible option with manageable toxicities for LT recipients unable to receive enteral medication, helping to prevent acute cellular rejection episodes. |
